Interesting. But to be fair, you are already doing 3 years of fellowship to do heme/onc.
Actually, I'm doing 4! But I only did 2 years of IM and I get 3 full years of research time. But that's beside the point.
I was thinking that oncology might be frustrating because oncologists don't really diagnose their patients and chemotherapy seems to be very empirical (in that there are only a few targeted therapies like Gleevac).
It is clear that you misunderstand the role and practice of oncologists (this is my polite way of saying you're talking out of your *****).
About half of inpatient consults go like this "I have a guy with a (insert organ/anatomical site) mass on CT, can you come figure out what he has and how to treat him?" The other half are from surgeons asking you to figure out why a patient with an INR of 5 and platelets of 12 is having post-op bleeding.
At that point it's kind of semantic as to who "diagnoses" the patient. You're going to write a note stating what the most likely dx is (and you're probably already warming up your favorite treatment cocktail). The radiologist who read the CT scan probably already said "suspicious for X-inoma." Then a surgeon, GI, pulm or radiologist will get a hunk of that tissues. Then the pathologist will look at it under the scope, maybe run an IHC or two (or 12 if they have good insurance) and pronounce it to be "definitely X-inoma." Of the 3-5 people who laid their hands on that case, who "made the diagnosis?" Who cares?
As for targeted therapies...rituximab, sorafenib, sunitinib, cetuximab, panitumumab, pazopanib, ipilimumab, erlotinib, trastuzumab, bevacizumab...let me know if you want me to stop.
Well, the job market for pathology is not that good, but statistically nearly all pathologists find a job... just not necessarily in the location that they wanted.
That's a generous interpretation of the path job market but not completely off the mark.
I guess it is still pretty edifying to look at a slide even though you are not responsible for signing it out. I guess that most clinicians routinely look at their imaging studies, but maybe only heme/onc regularly looks at slides/smears.
I think oncologists probably spend more time looking at slides and films than any other specialty besides radiology (and maybe surgery) because many of our treatments (and nearly all of our clinical trials) are dependent on how things look on CT. I probably look at 2 studies for every patient I see. And while I don't routinely look at all slides, if there's something interesting or unusual about the case I will...I also look at all of my own smears.
Isn't the patient contact in oncology pretty dark? I would think that it would be pretty emotionally draining. Maybe I'm just not that much of a people person, but it seems to me that oncology is very heavy on the emotional interaction with dying patients
.
It can be tough, sure, but it can also be quite edifying both to help cure people (which happens although not as often as we'd like) as well as to help people have a good death. But yes, you need to have some people skills and a fair amount empathy in order to do it. I'm probably the wrong person to ask about this though because my clinical and research focus are on advanced and metastatic GI malignancies so I probably have a different perspective and tolerance for this part of the job.
Don't you ever wish to just be on the purely scientific unemotional side of the equation? Maybe I'm just not appreciating the draw of this type of patient interaction.
I am...4 days a week. On the
real scientific side...the research side.
I went through this same thought process when I was finishing up grad school and headed back to med school. Lots of people that I respected (including my PhD advisor and a close collaborator) told me I should do path since it would be the fastest route back to the lab. But I like the patient interaction too much to give it up.